To Your Health: On Reflux & Heartburn

01 Nov To Your Health: On Reflux & Heartburn

Part-time Telluride local, Dr. Alan Safdi, is a world-renowned internist and gastroenterologist with encyclopedic knowledge of mind-body wellness and preventative medicine. He posts regularly on Telluride Inside… and Out under the banner of “To Your Health.” His blogs feature the most current information in his field: health, wellness, and longevity. Which now has to mean Dr. Alan’s podcasts and stories are mostly about what’s on everyone’s mind: COVID-19. 

Links to Dr. Alan’s podcasts and narratives on COVID-19 are here.

This week in his podcast Dr. Alan talks in depth about reflux and heartburn. Specifically offering a definition of reflux. Is it a disease of aging? What foods bring on heartburn? Can heartburn be a symptom of a heart attack? What is the LES? Why are fatty foods bad for reflux? Can exercise worsen reflux?

Additional info, including lifestyle tips:

More than 60 million Americans experience heartburn at least once a month. Some studies suggest more than 15 million Americans experience symptoms daily. Symptoms of heartburn, also known as acid indigestion, are more common as we get older – and in pregnant women.

Gastroesophageal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus. People will experience such symptoms when excessive amounts of acid reflux into the esophagus. Many describe heartburn as a feeling of burning discomfort, localized behind the breastbone, that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid at the back of the throat. The burning and pressure symptoms of heartburn can last for several hours and often worsen after eating. All of us may have occasional heartburn. However, frequent heartburn (two or more times a week), food sticking, blood or weight loss can be associated with a more severe problem known as gastroesophageal reflux disease or GERD.

To understand gastroesophageal reflux disease or GERD, it is first necessary to understand what causes heartburn.

Most people will experience heartburn when the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. This stomach juice consists of acid, digestive enzymes, and other injurious materials. The prolonged contact of acidic stomach juice with the esophageal lining injures the organ and produces a burning discomfort. Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or “LES” — keeps the acid in the stomach and out of the esophagus. In gastroesophageal reflux disease or GERD, the LES relaxes too frequently, which allows stomach acid to reflux, or flow backward.

In many cases, doctors find that infrequent heartburn can be controlled by lifestyle modifications and proper use of over-the-counter medicines.

Lifestyle modifications:

Avoid foods and beverages that contribute to heartburn: chocolate, coffee, peppermint, greasy or spicy foods, tomato products and alcoholic beverages. Combining some of these products significantly increases the risk (ie. hamburger and beer, pizza with meat and alcoholic beverage, etc.) Also large meals.

Stop smoking. Tobacco inhibits saliva, which is the body’s major buffer. Tobacco may also stimulate stomach acid production and relax the muscle between the esophagus and the stomach, permitting acid reflux to occur.

Reduce weight if too heavy. Our increasing waist lines and abdominal girth is a significant risk factor for reflux.

Avoid eating 2-3 hours before sleep.

For infrequent episodes of heartburn, take an over-the-counter antacid or an H2 blocker, some of which are now available without a prescription.

Possible complications:

When GERD is not treated, serious complications can occur, such as severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, or a pre-malignant change in the lining of the esophagus called Barrett’s esophagus.

A 1999 study reported in the New England Journal of Medicine showed that patients with chronic, untreated heartburn of many years duration were at substantially greater risk of developing esophageal cancer, which is one of the fastest growing, and among the more lethal forms of cancer in this country.

Symptoms suggesting that serious damage may have already occurred include:

• Dysphagia: difficulty swallowing or a feeling that food is trapped behind the breast bone.

• Bleeding: vomiting blood, or having tarry, black bowel movements.

• Choking: sensation of acid refluxed into the windpipe causing shortness of breath, coughing, or hoarseness of the voice.

• Weight Loss

H2 Receptor Antagonists (an example is famotidine or pepcid):

Since the mid 1970’s, acid suppression agents known as H2 receptor antagonists or H2 blockers have been used to treat GERD. H2 blockers improve the symptoms of heartburn and regurgitation and provide an excellent means of decreasing the flow of stomach acid to aid in the healing process of mild-to-moderate irritation of the esophagus, known as “esophagitis.”  Symptoms are eliminated in up to 50% of patients with twice a day prescription dosage of the H2 blockers. Healing of esophagitis may require higher dosing. These agents maintain remission in about 25% of patients.

H2 blockers are generally less expensive than proton pump inhibitors and can provide adequate initial treatment or serve as a maintenance agent in GERD patients with mild symptoms.

Proton Pump lnhibitors:

Proton pump inhibitors (PPIs)have been found to heal erosive esophagitis (a serious form of GERD) more rapidly than H2 blockers. Proton pump inhibitors provide not only symptom relief, but also elimination of symptoms in most cases, even in those with esophageal ulcers. The goal of therapy for GERD is to keep symptoms comfortably under control and prevent complications.

Always discuss the possible side effects of any of these mediations with your physician and monitor for those potential problems.

Always make sure that you bring up your reflux symptoms including severity, frequency, and current OTC treatments with your primary care provider or gastroenterologist.

Dr. Alan, more:

Dr. Alan Safdi is board-certified in Internal Medicine and in Gastroenterology and is a Fellow of the American College of Gastroenterology. A proven leader in the healthcare arena, he has been featured on the national program, “Medical Crossfire” and authored or co-authored numerous medical articles and abstracts. Safdi has been involved in grant-based and clinical research for four decades and is passionate about disease prevention and wellness, not just fixing what has gone wrong. He is an international lecturer on the subjects of wellness, nutrition and gastroenterology.